Provider Demographics
NPI:1699763508
Name:GOLDBERG, ERIC LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:LAWRENCE
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MINNESOTA DR STE 800
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-7915
Mailing Address - Country:US
Mailing Address - Phone:952-595-1301
Mailing Address - Fax:612-294-4900
Practice Address - Street 1:3600 MINNESOTA DR STE 800
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-7915
Practice Address - Country:US
Practice Address - Phone:952-595-1301
Practice Address - Fax:612-294-4900
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV111172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100504971Medicaid
NV40516Medicare ID - Type UnspecifiedCC,MINDN,RENO
NV100504971Medicaid
NV40514Medicare ID - Type UnspecifiedEASTERN NEVADA & CC
NV40512Medicare ID - Type UnspecifiedCC,ELKO,ELY